Termination of Pregnancy Flashcards
TOP service providers
Marie Stopes
British Pregnancy Advisory Service
GUM/Family planning clinic
Medical Mx of TOP
Mifepristone PO
24-48 hr later Misoprostol (PV, buccal, sublingual)
Simple analgesia
Medical Mx of TOP suitable for what gestation?
any gestation
Medical Mx of TOP 0-9wks
Can be administered at home provided pt is easy to follow up
Bleeding can follow for up to 2 wks
Pregnancy test in 3wks
Medical Mx TOP >9wks
Done in clinical setting (inc. bleed and discomfort)
Repeated misoprostol every 3hr until expulsion
Max 5 doses
Medical TOP after 21+6
Feticide (intracardiac KCl) eliminate signs of life
Surgical Mx of TOP <14wk
Vacuum aspiration
- Dilate cervix and vacuum
- LA/GA
- Ripening with misoprostol
- Metronidazole proph. or infection
Surgical Mx of TOP >14wk
Dilatation and Evacuation
- Req. cervical dilatation (misoprostol 3hr before surg)
- extraction w/forceps
- USS to confirm evacuation
Risks of surgical TOP
Failure to end pregnancy
Haemorrhage
Infection
Perforation
Surgical TOP future fertility?
NO effect on reproduction or ectopic
Requirements for TOP?
2 doctors sign a form - dont both need to see pt
PACES Counselling TOP Medical
2 pills 24hrs apart
2 wks bleed
pregnancy test 3wk
may req. surgery if fails
PACES counselling TOP surgical
explain involves dilatation
takes 10 mins
may need to ripen cervix
LA/GA
